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A group of related disorders such as skin picking, nail biting, hair pulling, etc., can be together referred to as body-focused repetitive behaviour. Read on to know more about this behaviour, how it leads to self harming, its diagnosis and treatment.
What Is Body-focused Repetitive Behaviour?
A set of interrelated disorders is referred to as body-focused repetitive behaviour. These are also termed as self-grooming behaviours. There still exists some debate about whether this disorder should be categorized as impulsive or compulsive. Theories also relate body-focused repetitive behaviour to impulse control disorders, anxiety disorders and obsessive compulsive disorder.
It is difficult to control individuals with this behaviour and can lead to self-physical injury such as skin infections and scarring. If the condition remains undiagnosed, it can lead to severe emotional distress for the afflicted person.
What Causes Body-focused Repetitive Behaviour?
Few people might have an inherited tendency of hair pulling and skin picking. Research has also shown the presence of hair pulling behaviour in twins. Other factors that could lead to body-focused repetitive behaviour are:
• Onset of age
In general, such behaviours have been widely associated with genetic and neurobiological origins. This behaviour requires individualized treatment approach that can only be determined after taking into consideration genetics, behavioural and biological indicators.
Main Types Of Body-focused Repetitive Behaviour
• Hair pulling
This is also referred to as trichotillomania. People who have this disorder tend to pull out their own hair from the eyelashes, scalp, eyebrows and other parts of the body. This causes noticeable bald patches. Many such people also tend to swallow the pulled out hair. This can lead to severe levels of embarrassment in public.
• Skin picking
This is also referred to as excoriation. People with this disorder repeatedly rub, scratch, pick, dig and touch their skin. This causes the discolouration of the skin along with severe tissue damage and scarring. There could be skin disfigurement as well.
• Nail biting
This is also referred to as onychophagia. People with this disorder bite their nails way beyond the nail bed. They also chew on the cuticles. It can lead to becoming as severe as bleeding nails. There could be infection and soreness.
• Cheek and lip biting
Many people with this disorder tend to chew their cheek and lips. Cheek biting can cause painful sores and tears along with redness. Chronic cheek biting is called morsicatio buccarum. The person with this disorder repeatedly keeps biting the inside of his or her cheek.
• Nail picking
Severe and constant nail picking can lead to nail deformities. Ridges and grooves develop under the nails. Blood may accumulate under the nail - this is usually seen as a purple-black spot.
• Scab eating
A form of skin picking, scab eating has been categorized under obsessive compulsive and related disorders. People with this behaviour finish their skin picking behaviour by eating the piece of skin that they have removed from their body.
How Is Body-focused Repetitive Behaviour Diagnosed?
Symptoms are the best way for a doctor to identify and determine the existence of body-focused repetitive behaviour. People usually feel tense or anxious just before starting to do activities linked with this disorder.
Doing an activity such as skin picking or hair pulling might relieve the person of the anxiety that he or she had been feeling. People usually feel distressed due to their loss of controlling ability. They also repeatedly try to stop doing the activity.
The symptoms that a doctor ideally looks for are:
The symptoms that a doctor ideally looks for are:
• Picking at the skin
• Manipulating a body part that leads to self-damage or self-harm
• Trying repeatedly to stop or decrease the occurrence of the activities associated with the disorder
• Reduced functionality due to the activities associated with the disorder
• Patient feeling extremely distressed
What Are The Treatment Options?
The ideal treatment options are:
• Cognitive therapy
• Use of drugs
The drugs that are usually prescribed are selective serotonin reuptake inhibitor antidepressants and N-acetylcysteine. Cognitive-behavioural therapy can be used to lessen the symptoms associated with body-focused repetitive behaviour.
One such therapy is habit reversal therapy. Under this therapy, the patient is taught ways so that they can do the following:
• Identification of events or situations that trigger the behavioural disorder activity.
• Increase in awareness of what one is doing when involving in activity linked to the disorder.
• Trying to stop oneself from doing a harmful act. This primarily involves substituting an activity that is harmful. Strategies used could be something like clenching the fist or sitting on one's hands while the urge to pull out hair or skin picking occurs.
• Encouraging patients to indulge in activities such as knitting, etc. can also help reduce the occurrence of activities that can cause self-harm.